Information Collection

NHSC Recruitment and Retention Assistance Application

IC 6469 under ICR 201108-0915-001 · OMB 0915-0230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0230 can be found here:

Documents and Forms

Document Name Document Type
NHSC Site Application_Users Guide_07252011.zip Instruction
1 NHSC Site Application NHSC Site Application_screenshots_07252011.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC Recruitment and Retention Assistance Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			NHSC Site Application_Users Guide_07252011.zip		Yes	No	Printable Only
Form	1	NHSC Site Application	NHSC Site Application_screenshots_07252011.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	100	2,900
Annual IC Time Burden (Hours)	1,500	50	1,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.